The potential value of fibrinogen to albumin ratio (FAR) in the assessment of inflammation in spondyloarthritis.

BACKGROUND: Fibrinogen to albumin ratio (FAR) is a newly investigated indicator for inflammation. The study aimed to explore the potential ability of FAR in assessing the severity of inflammation in spondyloarthritis. METHODS: The clinical data of 196 spondyloarthritis (SpA) patients, 66 osteoarthritis (OA) patients, and 81 healthy controls (HC) were collected in this retrospective study. The SpA group included 69 psoriatic arthritis patients, 47 reactive arthritis patients and 80 ankylosing spondylitis patients. Chi-square test and Mann-Whitney U test, Spearman's correlation test, regression analysis, and ROC analyses were used for the analysis of FAR. RESULTS: FAR level in group SpA was higher than in OA or HC. In the SpA group, the reactive arthritis group was characterized by the highest FAR level. After matching the erythrocyte sedimentation rate, a significant difference occurred between groups SpA and OA, but not in SpA subgroups. The FAR level was significantly related to erythrocyte sedimentation rate and C-reactive protein. After regression and receiver operating characteristics analysis, FAR was considered the most potential pointer to evaluate inflammation in SpA with the area under curve of 0.95. The recommended cut-off value of FAR was 9.44 for serious inflammation and 8.34 for mild conditions. CONCLUSION: FAR is closely related to inflammatory biomarkers and can be a potential indicator in the assessment of inflammation in spondyloarthritis.

Ampliação de uso do naproxeno para o tratamento da Artrite Reativa / Expansion of the use of naproxen for the treatment of Reactive Arthritis

INTRODUÇÃO: A artrite reativa (ARe) pertence ao grupo das espondiloartrites e é convencionalmente definida como uma artrite que surge após uma infecção extra-articular, geralmente geniturinária ou gastrointestinal. É uma doença relativamente rara que acomete tipicamente adultos jovens. O tratamento da ARe possui diferentes abordagens, e inclui o tratamento da infecção desencadeante e das manifestações musculoesqueléticas. O uso de anti-inflamatórios não esteroidais (AINE) constitui a abordagem inicial do tratamento da doença articular sintomática. De acordo com o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da Artrite Reativa de 2015, o único AINE disponibilizado para a doença no Sistema Único de Saúde (SUS) é o ibuprofeno. O naproxeno é um AINE não seletivo que possui tradição de uso e histórico de incorporações no SUS para condições musculoesqueléticas (espondilite anquilosante, artrite psoriásica, artrite reumatoide, osteoartrite de joelho e quadril), além de representar uma alternativa mais segura em relação aos eventos cardiovasculares quando comparado a outros AINE. PERGUNTA: O naproxeno é uma opção segura e eficaz para o tratamento da ARe? EVIDÊNCIAS CIENTÍFICAS: Foram realizadas buscas nas bases de dados Medline (via Pubmed) e Embase. Uma revisão sistemática (RS) de avaliação de AINE em espondiloartrites foi elegível. A RS incluiu cinco ensaios clínicos randomizados (ECR) de avaliação do naproxeno, sendo três em comparação a outros AINE (aceclofenaco, butacote, piroxicam) e dois em comparação a outros AINE (celecoxibe, etoricoxibe) e placebo. Os estudos que incluíram a comparação com placebo avaliaram desfechos de eficácia e segurança em pacientes com espondilite anquilosante. Os estudos evidenciaram benefício do naproxeno na melhora da dor, avaliação global do paciente, escore BASDAI e escore BASFI, sem aumento significativo dos eventos adversos, com exceção de um estudo que evidenciou maior taxa de eventos adversos (EA) gastrointestinais. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: a estimativa de custo global anual no cenário base foi de aproximadamente 27 mil reais, com impacto cumulativo em 5 anos de cerca de 138 mil reais. Na análise de sensibilidade, foram observados valores de 42 mil reais no cenário mais otimista, e acima de 516 mil reais no cenário mais pessimista, para o período de 5 anos. A variável de maior impacto nos resultados foi o custo unitário do medicamento. Análise comparativa com ibuprofeno evidencia custo incremental entre R$ 16,38 a R$ 28,35 por paciente tratado com naproxeno. CONSIDERAÇÕES: Não foram identificados estudos de avaliação do naproxeno em ARe e nenhum estudo comparou naproxeno com ibuprofeno, AINE já disponibilizado no SUS. A evidência disponível avalia a eficácia e a segurança do naproxeno em comparação a placebo, em pacientes com espondilite anquilosante, espondiloartrite que acomete preferencialmente a coluna vertebral. Os estudos evidenciam benefício do medicamento, sem comprometimento significativo da segurança. Apesar da escassez de evidências do uso de naproxeno em ARe, seu uso baseia-se na experiência clínica e na evidência de benefício em outras condições musculoesqueléticas, particularmente em outras formas de espondiloatrite. O medicamento possui tradição de uso e histórico de incorporações no SUS para condições semelhantes. RECOMENDAÇÃO PRELIMINAR: Diante do exposto, a Conitec, em sua 88ª reunião ordinária, realizada no dia 08 de julho de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à incorporação do naproxeno como opção terapêutica da ARe no Sistema Único de Saúde. CONSULTA PÚBLICA: A Consulta Pública nº 43/2020 foi realizada entre os dias 20/08/2020 a 08/09/2020. Foram recebidas 89 contribuições no total, das quais 5 (5,6%) foram pelo formulário para contribuições técnico-científicas e 84 (94,4%) pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Das 5 contribuições de cunho técnico-científico, uma era relacionada a outro tema de consulta pública, sendo consideradas na análise somente quatro contribuições. Em relação à recomendação preliminar da Conitec, que foi favorável à ampliação do uso do naproxeno, dois participantes submeteram a contribuição com opinião favorável a recomendação preliminar da comissão. As outras duas contribuições discordaram da recomendação preliminar da Conitec. Foram recebidas 84 contribuições de experiência e opinião, no entanto 37 contribuições possuíam comentários relacionadas a outro tema de consulta pública, não sendo consideradas na análise. Em relação à recomendação preliminar da Conitec, 18 participantes (38%) submeteram a contribuição com opinião favorável a recomendação preliminar da comissão, uma contribuição não concordou e não discordou da recomendação e 28 participantes (59%) discordaram da recomendação preliminar da Conitec. Houve onze relatos sobre a recomendação preliminar, no entanto, nove deles relatavam discordância com relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório. RECOMENDAÇÃO FINAL: Os membros do Plenário presentes na 91ª Reunião Ordinária da Conitec, no dia 07 de outubro de 2020, deliberaram, por unanimidade, recomendar a ampliação de uso do naproxeno para o tratamento de pacientes com Artrite Reativa. Na apreciação da CP, os membros do Plenário entenderam que a maioria das contribuições relatavam discordância em relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório, sendo assim mantiveram a recomendação preliminar. Foi assinado o Registro de Deliberação nº 558/2020. DECISÃO: Ampliar o uso do naproxeno para o tratamento de pacientes com artrite reativa, no âmbito do Sistema Único de Saúde - SUS, conforme Portaria n° 48, publicada no Diário Oficial da União n° 217, seção 1, página 144, em 13 de novembro de 2020.

Using Microsimulation to Estimate the Future Health and Economic Costs of Salmonellosis under Climate Change in Central Queensland, Australia.

BACKGROUND: The incidence of salmonellosis, a costly foodborne disease, is rising in Australia. Salmonellosis increases during high temperatures and rainfall, and future incidence is likely to rise under climate change. Allocating funding to preventative strategies would be best informed by accurate estimates of salmonellosis costs under climate change and by knowing which population subgroups will be most affected. OBJECTIVE: We used microsimulation models to estimate the health and economic costs of salmonellosis in Central Queensland under climate change between 2016 and 2036 to inform preventative strategies. METHODS: We projected the entire population of Central Queensland to 2036 by simulating births, deaths, and migration, and salmonellosis and two resultant conditions, reactive arthritis and postinfectious irritable bowel syndrome. We estimated salmonellosis risks and costs under baseline conditions and under projected climate conditions for Queensland under the A1FI emissions scenario using composite projections from 6 global climate models (warm with reduced rainfall). We estimated the resulting costs based on direct medical expenditures combined with the value of lost quality-adjusted life years (QALYs) based on willingness-to-pay. RESULTS: Estimated costs of salmonellosis between 2016 and 2036 increased from 456.0 QALYs (95% CI: 440.3, 473.1) and AUD29,900,000 million (95% CI: AUD28,900,000, AUD31,600,000), assuming no climate change, to 485.9 QALYs (95% CI: 469.6, 503.5) and AUD31,900,000 (95% CI: AUD30,800,000, AUD33,000,000) under the climate change scenario. CONCLUSION: We applied a microsimulation approach to estimate the costs of salmonellosis and its sequelae in Queensland during 2016-2036 under baseline conditions and according to climate change projections. This novel application of microsimulation models demonstrates the models' potential utility to researchers for examining complex interactions between weather and disease to estimate future costs. https://doi.org/10.1289/EHP1370.

Late cardiac assessment in children diagnosed with post-streptococcal reactive arthritis: a long term study.

OBJECTIVES: Unlike rheumatic fever (RF), the association of post-streptococcal reactive arthritis (PSRA) and carditis is controversial. The American Heart Association recommends anti-streptococcal prophylaxis for PSRA for one year, repeating echocardiogram and discontinuation of prophylaxis if normal. In this study the possibility of late cardiac involvement was investigated in a cohort of children with PSRA. METHODS: Children diagnosed with PSRA and followed at the Paediatric Rheumatology Units at two medical centres in Israel had echocardiography carried out by a paediatric cardiologist, at least 1 year following diagnosis. RESULTS: 146 patients with PSRA met the study criteria. Of these, 69 had undergone echocardiography 1-6.9 years (mean 3.6 years ± 1.5 years) after diagnosis. All had normal major parameters. Twenty (29.0%) patients had minimal cardiac findings, including 5 (7.2%) mild mitral insufficiency, 12 (17.4%) minimal mitral insufficiency, 2 (2.9%) mild tricuspid insufficiency and one patient (1.4%) had very mild, aortic insufficiency. Of the 77 patients who did not have echocardiography, 31 were randomly excluded from the initial study list, 26 refused to undergo echocardiography, and 20 were lost to follow-up. All were asymptomatic according to their medical record or telephone questionnaire. There were no significant differences in clinical or demographic data between those with or without echocardiography. CONCLUSIONS: No late cardiac involvement was found in our paediatric PSRA patients. Therefore, different approaches to antibiotic prophylaxis for PSRA and ARF are probably suggested. A prospective, controlled study is needed to definitively assess the necessity of prophylaxis in PSRA.

[Clinical and epidemiological analysis hospitalization indicators Ministry's of Defense of Ukraine servicemen with reactive arthritis].

Our researches showed high occurrence of the reactive arthritises among servicemen Ministry of Defense of Ukraine and improvement of the treatment outcomes of this patients during the last years.

The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general.

OBJECTIVE: To evaluate new classification criteria for peripheral spondyloarthritis (SpA) in patients with SpA with peripheral manifestations only. METHODS: In this Assessment of SpondyloArthritis international Society (ASAS) study, two prespecified sets of criteria were compared against the European Spondylarthropathy Study Group (ESSG) and Amor criteria in newly referred consecutive patients with undiagnosed peripheral arthritis, and/or enthesitis, and/or dactylitis that usually began before 45 years of age. The clinical diagnosis (SpA vs no SpA) made by the ASAS rheumatologist served as reference standard. RESULTS: In all, 24 ASAS centres included 266 patients, with a final diagnosis of SpA being made in 66.2%. After adjustments a final set of criteria showed the best balance between sensitivity (77.8%) and specificity (82.9%): arthritis and/or enthesitis and/or dactylitis plus (A) one or more of the following parameters: psoriasis, inflammatory bowel disease, preceding infection, human leucocyte antigen B27, uveitis, sacroiliitis on imaging, or (B) two or more other parameters: arthritis, enthesitis, dactylitis, inflammatory back pain in the past, family history of SpA. The new criteria performed better than modified versions of the ESSG (sensitivity 62.5%, specificity 81.1%) and the Amor criteria (sensitivity 39.8%, specificity 97.8%), particularly regarding sensitivity. In the entire ASAS population of 975 patients the combined use of ASAS criteria for axial SpA and ASAS criteria for peripheral SpA also had a better balance (sensitivity 79.5%, specificity 83.3%) than the modified ESSG (sensitivity 79.1%, specificity 68.8%) and Amor criteria (sensitivity 67.5%, specificity 86.7%), respectively. CONCLUSIONS: The new ASAS classification criteria for peripheral SpA performed well in patients presenting with peripheral arthritis, enthesitis and/or dactylitis.

[Wars in the history of rheumatology]. / Le guerre nella storia della reumatologia.

Some important discoveries in the history of rheumatology happened during war periods. It is well known that arthritis associated with conjunctivitis and urethritis, following dysenteric episodes, has been described during the First World War from the German Hans Reiter and, nearly contemporarily, from the French Nöel Fiessinger and Edgar Leroy. Less known is instead the fact that the first cases of sympathetic algoneurodystrophy have been reported by the American Silas Weir Mitchell in soldiers wounded by fire-arms, during the Civil War of Secession. Other war episodes have been crucial for the development of some drugs now abundantly applied to the care of rheumatic diseases. The discovery of therapeutic effects of immunosuppressive agents, in fact, happened as an indirect consequence of the use of poison gas, already during the First World War (mustard gas), but above all after an episode in the port of Bari in 1943, where an American cargo boat was sunk. It had been loaded with a quantity of cylinders containing a nitrogenous mustard, whose diffusion in the environment provoked more than 80 deaths owing to bone marrow aplasia.Moreover, the history of the cortisone shows a strict link to the Second World War, when Germany imported large quantities of bovine adrenal glands from Argentina, with the purpose of producing some gland extracts for the Luftwaffe aviators, in order to increase their performance ability.

The costs of early inflammatory joint disease: a population-based study in southern Sweden.

OBJECTIVE: To study the costs and use of healthcare for patients during the first months with early joint inflammation, in a population-based prospective referral study in Southern Sweden. METHODS: Adult patients with arthritis for < 3 months and with onset of symptoms between 1 May 1999 and 1 May 2000 were referred from primary health centres to rheumatologists. Four clinical assessments were performed during a 6-month follow-up period. The direct medical costs for inpatient stays, outpatient visits, visits to general practitioners, and visits to health professionals, as well as costs for medication, radiographs, and laboratory tests were recorded from the onset of the disease up to 6 months of follow-up. Indirect costs for sick leave were also recorded. RESULTS: Fifty-six of 71 referred patients agreed to participate. Thirteen (23%) had RA, 21 (38%) had reactive arthritis (ReA), 14 (25%) had undifferentiated arthritis, and eight (14%) had other arthritides. The median cost per patient in the entire group was USD 3362. The median cost per patient in the RA group was USD 4385, and USD 4085 in the ReA group. There was no statistically significant difference in the median costs per patient in the different diagnostic groups. Sick leave accounted for 44% of the total costs in the entire group, and 46% and 47%, respectively, in the RA and ReA groups. CONCLUSION: The costs of early arthritis are already considerable during the first months of the disease following the onset of the symptoms. The indirect costs due to sick leave accounted for nearly half of the costs.

[Expert assessment of patients with seronegative spondyloarthropathies]. / Begutachtung von Patienten mit seronegativen Spondylarthropathien.

Besides rheumatoid arthritis, seronegative spondyloarthropathies are one of the most common inflammatory musculoskeletal diseases. The main clinical manifestations are spondylitis and sacroiliitis, but peripheral arthritis and involvement of other organ systems are known as well. The typical ankylosis of the spine is resulting in a marked loose of the functional capacity. During the course of disease, work disability is progressing and finally the patient may become permanent disabled. Patients with ankylosing spondylitis can be viewed by experts for several reasons. To guarantee an objective medical expert view, a detailed clinical examination and use of clinical indices are mandatory.

Incidence and prevalence of juvenile arthritis in an urban population of southern Germany: a prospective study.

OBJECTIVE: To ascertain the incidence and prevalence of juvenile arthritis in a German urban population. METHODS: All 766 paediatricians, orthopaedists, and rheumatologists working in practices or outpatient clinics in 12 south German towns were asked to report all patients who consulted them for juvenile arthritis during the year 1995. Patients with continuing symptoms were followed up for 9-12 months to obtain a final diagnosis. Extended measures of quality control were taken to control for known biases. RESULTS: Of 457 reported cases, 294 were diagnosed with para-/postinfectious arthritis (PPA), 78 with juvenile chronic arthritis (JCA), and 18 with other forms of arthritis. Half of the PPA cases were classified as transient synovitis of the hip (SH). For JCA the reported annual incidence was 6.6 and the prevalence 14.8 per 100 000 subjects under 16 years of age. For PPA the reported incidence was 76 and the prevalence 4.4 per 100 000 subjects under 16. The incidence of rheumatic fever was clearly below 1 per 100 000 people under 16. A correction model was used to control for known biases and to adjust the estimates accordingly. CONCLUSIONS: The results of this first prospective study on the incidence and prevalence of juvenile arthritis in Germany are consistent with a retrospective study performed in the Berlin area. Based on these results it was estimated that the annual frequency of juvenile arthritis in Germany is as follows: 750-900 incident JCA cases, 21 000 incident SH cases, and 21 000 incidence cases of other forms of PPA a year. The number of incidence cases of rheumatic fever is expected to be markedly lower than 150 a year. The total prevalence is expected to be 3600-4350 JCA cases, 2250-3000 SH cases, and the same number of other forms of PPA.

The national database of the German Collaborative Arthritis Centres: I. Structure, aims, and patients.

OBJECTIVE: To describe the aims, principles, and content of the German rheumatological database and to present data on patient mix and healthcare provision for the year 1998. METHODS: The German rheumatological database contains clinical and patient derived data of the outpatients with inflammatory rheumatic diseases seen at one of the 24 collaborative arthritis centres. The case mix, institutional context, and demographic features of 25 653 patients from the year 1998 were analysed. RESULTS: 51% of the patients had rheumatoid arthritis, 23% seronegative spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, and 19% had vasculitis, including SLE (5%). The distribution of the age at onset of patients with RA with < or = 2 years' disease duration was comparable with recent incidence data from population studies. The case mix differed between university departments and rheumatology hospitals as well as individual practices. 65% of the male and 46% of the female patients at ages 18-60 were still in gainful employment, the rates of employment were 14% below the population rates for women, and 11% below those for men. 62% of all patients had seen a rheumatologist within the first year of disease, 73% within the first two years. Ankylosing spondylitis was seen in rheumatological care much later than all other diseases (only 39% within the first year). The mean number of contacts with a rheumatologist was five a year; rheumatologists in individual practices saw their patients seven times a year on the average. Together with visits to the non-specialist doctor mainly treating the patient, the mean number of visits to the doctor for a rheumatic condition was 20 a year. CONCLUSION: Large databases like this one give information about the patient case mix in different healthcare settings, about treatment practice, and about the consequences of disease. Patients treated in specialised rheumatology units in Germany are referred earlier than in the past, which probably reflects better regional cooperation due to the implementation of arthritis centres. University departments and outpatient clinics of rheumatology hospitals contribute considerably to the specialised care of patients with arthritis and connective tissue diseases.

Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis.

The cause of ankylosing spondylitis remains unclear. Proof that this disorder is an autoimmune disease attributable to crossreactivity between bacteria and HLA-B27 is still lacking. Differences in endogenous peptide presentation by HLA-B27 subtypes might be relevant in the etiopathogenesis. Fractures of the osteoporotic spine contribute to morbidity. Spinal cord injury may occur. MR imaging enables identifying sacroiliitis earlier than plain radiography. Sweet syndrome has now been described in patients with ankylosing spondylitis and Crohn disease. Progress has been made in the assessment of ankylosing spondylitis. There are now core sets for different settings and validated instruments for functioning and disease activity that will enable demonstrating efficacy of new therapeutic interventions. The debate continues on classification of postinfectious and reactive arthritis. Bacterial antigens may be found in the inflamed joints; occasionally 16S ribosomal RNA is also demonstrated. Antibiotics seem not to be effective in postenteric reactive arthritis. More than 25 years have now elapsed since the association between ankylosing spondylitis and HLA-B27 was first described in 1973. The cause of this disease is still unknown, but a lot of progress has been made regarding the molecular structure of HLA-B27, the spectrum of disease, the clinical and radiographic assessment of ankylosing spondylitis, and its treatment. Recent advances in research on ankylosing spondylitis are reviewed here.

Development of a disease activity index for the assessment of reactive arthritis (DAREA).

OBJECTIVES: The objectives of this study were to investigate and validate individual variables and to develop a composite score for disease activity measurement in patients with reactive arthritis (REA). METHODS: In the first cross-sectional part, the clinical and laboratory evaluation of 45 patients was used to elaborate the most important individual disease activity measures. In the second prospective part, these variables as well as a composite score for disease activity measurement of REA were prospectively validated in 23 patients at two points in time. RESULTS: The following variables emerged as the most useful for the composite measure: number of swollen and tender joints, patient's pain and global assessment, and C-reactive protein. The score was calculated by simple addition of the individual figures. CONCLUSION: DAREA constitutes a reliable score which can easily be assessed on a day-to-day office work basis.

James Joyce: steps towards a diagnosis.

Authors whose scholarship is in the golden realm of English literature have not hesitated to make pronouncements on James Joyce's health. A publication in this genre claims he had tabes dorsalis. One feels that an authoritative comment, accepting or rejecting a diagnosis of neurosyphilis, should be provided by the Journal of the History of the Neurosciences.

Effects of soluble interleukin-1 type II receptor on rabbit antigen-induced arthritis: clinical, biochemical and histological assessment.

OBJECTIVES: To investigate the effects of soluble interleukin-1 (IL-1) type II receptor (sIL-1RII) on a number of clinical, biochemical and histological parameters in rabbit antigen-induced arthritis. METHODS: Arthritis was induced by intra-articular injection of methylated bovine serum albumin (mBSA) into rabbits pre-sensitized to the same antigen. An initial i.v. bolus of sIL-1RII was administered, followed by s.c. mini-pump dosing for 14 days, starting at the time of the arthritis induction. Animals received vehicle (saline 500 microl + 5 microl/h), low-dose sIL-1RII (13.4 microg + 1.34 microg/h) or high-dose sIL-1RII (40.2 microg + 4.02 microg/h). RESULTS: Marked, dose-related inhibition of joint diameter, plasma prostaglandin E2 (PGE2), and synovial fluid IL-1alpha and IL-1beta concentrations were seen after administration of sIL-1RII. However, synovial fluid PGE2 concentrations and synovial fluid cell counts were not affected. A significant inhibitory effect was also seen histologically on soft-tissue swelling and joint damage with high-dose sIL-1RII. CONCLUSIONS: These results demonstrate that IL-1 plays an important role in the pathogenesis of rabbit antigen-induced arthritis, thus confirming it as an excellent animal model with respect to evaluating anti-cytokine therapies for rheumatoid arthritis.

Long-term sequelae to foodborne disease.

Most of the concern about foodborne disease has been focused on the immediate effects of acute infection. Recent information has shown that many of these foodborne infections also have long-term sequelae with serious health effects and a significant economic impact. To increase the awareness of animal health professionals to these sequelae, the authors discuss two groups of sequelae which are strongly associated with preceding infection (reactive arthritides, including Reiter's syndrome, and the Guillain-Barré syndrome) as well as the possible association between Crohn's disease and Mycobacterium paratuberculosis. The discussion includes a description of the disease syndromes along with epidemiological and economic information. More reliable epidemiologial and economic data on chronic sequelae to foodborne disease will be needed for future evaluation of the cost-effectiveness of mitigation strategies to reduce the occurrence of foodborne pathogens.

[Questionable gonarthritis--assessment and therapy]. / Unklare Gonarthritis--Abklärung und Therapie.

The differential diagnosis of gonarthritis is widespread due to the fact that the knee participates in diseases ranging from infections to autoimmunopathies and metabolic disorders. The analysis of the synovial fluid provides important information and has to be performed without delay, if septic arthritis is suspected. Characteristics, symptoms and signs of underlying diseases help in the diagnostic work-up. Whereas radiologic examination is primarily done to document the evolution of the process, ultrasonography may add substantial morphological information. Therapy is based on drug treatment and physical measures. The primary goals of physiotherapy are analgesia and rehabilitation.

Epidemiologic aspects, clinical features, and management of ankylosing spondylitis and reactive arthritis.

The generally reported prevalence of 0.1% to 0.2% for ankylosing spondylitis in the white population is probably too low, because it is based almost entirely on hospital records. The incidence and clinical presentation of ankylosing spondylitis have not changed during the past few decades. For reactive arthritis, the list of microbes recognized as triggering agents is continuously increasing. Reactive arthritis is divided into urogenic, enterogenic, respiratory tract-associated, and idiopathic arthritides. In addition, several microbial diseases may be accompanied by reactive arthritis, even though the identity of the causative agent is not always known. In the diagnosis of the spondyloarthropathies, definite progress has been made in developing classification criteria. Intensive research is going on to evaluate new therapies, with special attention to the use of antimicrobial agents for the treatment of reactive arthritis.

[Synovial biopsy: expectations, results and assessment]. / Synovialisbiopsie: Erwartungen, Ergebnisse und Erkenntnisse.

In arthropathies without clear diagnostic clinical, radiological and laboratory findings, a synovial biopsy should be performed. The histologic examination yields a diagnosis in 5 to 29% or is complementary to clinical, radiological and laboratory findings leading to the diagnosis in another 23 to 40%; the diagnosis of "chronic synovitis" results at best for the remaining cases. The histological features of the main types of arthritis and arthropathy are briefly discussed.